Why daytime teeth clenching can be much worse than sleep bruxism

by Ruth Nichol / 03 October, 2017
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Daytime teeth clenching or grinding can be harmful – and yet many people don’t realise they’re doing it. 

Many of us clench or grind our teeth occasionally, particularly when we’re stressed or anxious. But one in five people spends long periods every day with their teeth clenched, usually without realising they are doing it.

And although what’s known as daytime (or awake) bruxism is generally seen as less of a problem than its night-time manifestation, sleep bruxism, University of Otago professor of orthodontics Mauro Farella disagrees.

About 8% of adults grind their teeth while asleep, often so loudly that other people can hear it. Farella says in a small number of cases it can eventually start to wear down teeth or damage expensive restorations, such as crowns and implants.

In those cases, the problem can be solved by wearing a mouthguard custom-made by a dentist – though definitely not a cheapie from a pharmacy, which can cause problems with the bite. “There’s a tendency to buy ‘do-it-yourself’ mouthguards, which can have negative consequences for oral health. I strongly discourage anyone from doing that.”

Some people stop night-time teeth-grinding once they give up smoking, cut back on alcohol and coffee or get treatment for acid reflux, all of which are associated with sleep bruxism.

But Farella believes daytime teeth clenching deserves more attention from the dental profession. He says it can cause a range of problems, including masticatory muscle pain – pain in the muscles that control jaw movement – headaches, jaw clicking and, in some cases, a visible increase in the size of the jaw muscles.

“Most people are more concerned with sleep bruxism. It’s considered more scary and more harmful, and most dentists would say it is worse. But I believe the opposite – that daytime bruxism can be more harmful.”

Professor Mauro Farella.

Although night-time teeth grinding can sound alarming to those unfortunate enough to hear it, it generally occurs in short bursts. Farella, who has a long-standing research interest in bruxism, says most people do it for less than 10 minutes a night and not always every night. Daytime teeth clenching, on the other hand, is less intense, but it can continue for longer periods and is often more constant.

“If you clench very hard, you can only do it for a short time. But if you are only lightly clenching, you can do it for minutes or hours, and this is what is worse.”

Between 12% and 14% of people experience masticatory muscle pain, which they describe as aching, stabbing, dull or pressing. More women than men experience it and they’re also more likely to seek treatment. The pain is most common in those aged 20 to 40 and it tends to diminish with age.

Daytime bruxism isn’t the only cause of the pain. Other possible causes include physical trauma to the face or stressful life events such as a death in the family. However, Farella says daytime bruxism is a significant cause of masticatory muscle pain, and breaking the clenching habit can often resolve the problem. If the pain has been present for less than six months, this can be done through simple cognitive behavioural techniques, such as using Post-it notes to remind a person to stop – or doing the modern equivalent and downloading an anti-clenching app to a smartphone.

The diagnostic tool being developed to monitor jaw contractions.

But before people can stop clenching their teeth, they need to recognise they are doing it. Unlike sleep bruxism, daytime bruxism is a silent activity and most people do it unconsciously.

“When I ask patients, ‘Do you clench your teeth?’, they usually say, ‘No, I don’t think so.’”

Until recently, dentists have had to rely on self-monitoring by patients to find out how often – and when – they clench or grind their teeth. But a diagnostic tool being developed by Farella and a University of Otago research team will remove the guesswork.

It’s a small patch that is attached to the cheek to monitor jaw contractions and can be connected wirelessly to a smartphone to provide real-time data on both daytime and sleep bruxism.

“At the moment we have to rely on self-reporting. This device will provide accurate information about how often, how long and how strongly the muscles contract.”

This article was first published in the August 19, 2017 issue of the New Zealand Listener.

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